Hyler Steven E, Gangure Dinu P, Batchelder Sarai T
Department of Psychiatry, Columbia University, New York, NY, USA.
CNS Spectr. 2005 May;10(5):403-13. doi: 10.1017/s109285290002277x.
The authors conducted a review and meta-analysis of the literature comparing telepsychiatry with "in-person" psychiatric assessments.
Approximately 380 studies on telepsychiatry published between 1956 and 2002 were identified using MEDLINE, PsycINFO, and cross-referenced bibliographies. Of these, 14 studies with an N > 10 compared telepsychiatry with in-person psychiatry (I-P) using objective assessment instruments or satisfaction instruments. Three of these studies compared high bandwidth (HB) with low bandwidth (LB) telepsychiatry.
Fourteen studies of 500 patients met inclusion criteria and were included in the meta-analysis. Telepsychiatry was found to be similar to I-P for the studies using objective assessments. Effect sizes were on average quite small, suggesting no difference between telepsychiatry and I-P. Bandwidth was found to be a significant moderator. Three moderators were tested, effect sizes remained largely heterogeneous, and further analyses are needed to determine the direction of effect. There was no difference between I-P and telepsychiatry between the HB and LB groups, although there are anecdotal data suggesting that HB was slightly superior for assessments requiring detailed observation of subjects.
Out of a large telepsychiatry literature published over the past 40+ years, only a handful of studies have attempted to compare telepsychiatry with I-P directly using standardized assessment instruments that permit meaningful comparisons. However, in those studies, the current meta-analysis concludes there is no difference in accuracy or satisfaction between the two modalities. Over the next few years, we expect telepsychiatry to replace I-P in certain research and clinical situations.
作者对比较远程精神病学与“面对面”精神病评估的文献进行了综述和荟萃分析。
使用医学文献数据库（MEDLINE）、心理学文摘数据库（PsycINFO）以及交叉引用的参考文献，识别出1956年至2002年间发表的约380项关于远程精神病学的研究。其中，14项样本量大于10的研究使用客观评估工具或满意度工具，对远程精神病学与面对面精神病学（I-P）进行了比较。其中三项研究比较了高带宽（HB）和低带宽（LB）远程精神病学。
500名患者的14项研究符合纳入标准并被纳入荟萃分析。对于使用客观评估的研究，发现远程精神病学与面对面精神病学相似。效应量平均相当小，表明远程精神病学与面对面精神病学之间没有差异。带宽被发现是一个显著的调节因素。测试了三个调节因素，效应量在很大程度上仍然存在异质性，需要进一步分析来确定效应方向。高带宽组和低带宽组之间的面对面精神病学和远程精神病学没有差异，尽管有传闻数据表明，对于需要详细观察受试者的评估，高带宽略胜一筹。
在过去40多年发表的大量远程精神病学文献中，只有少数研究试图使用允许进行有意义比较的标准化评估工具，直接将远程精神病学与面对面精神病学进行比较。然而，在这些研究中，目前的荟萃分析得出结论，两种方式在准确性或满意度方面没有差异。在接下来的几年里，我们预计远程精神病学将在某些研究和临床情况下取代面对面精神病学。
